Ophthalmology
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Item Comparative evalaution of macular thickness in sickle cell and non-sickle cell disease patients at the University College Hospital Ibadan, Oyo State, Nigeria.(Wolters Kluwer - Medknow, 2025) Avuru, C. J.; Babalola, Y. O.; Ugalahi, M. O.; Sarimiye, T. F.; Olawoye, O. O.; Olaniyi, J. A.; Oluleye, T. S.Purpose: The purpose of this study was to determine the macular thickness of participants with sickle cell disease (SCD) and compare with their age and sex matched participants without SCD at the University College Hospital (UCH), Ibadan, to provide baseline data for adult Nigerians with SCD and how they compare with those without the disease. Materials and Methods: This was a hospital based comparative study conducted at the UCH, Ibadan. Patients with SCD aged 18 years and above were age and sex matched with non SCD controls (Haemoglobin AA genotype). All participants underwent a full ophthalmic examination, refraction, A scan biometry, and macular thickness were measured with an Optovue iScan spectral domain optical coherence tomography machine. Data from the left eye of each participant were analysed with IBM Statistical Package for Social Sciences (SPSS) version 25.0. Results: Seventy participants were recruited into the study and 30 (42.9%) were males. The mean age of all the subjects in the study was 35.9 ± 11.0. Group 1 (SCD) comprised 19 (27.1%) Hb SS and 16 (22.9%) Hb SC while Group 2 (non SCD) were 35 (50%) Hb AA subjects. The SCD group had a lower mean macular thickness (MMT) of 271.1 ± 20.2 microns compared to the non SCD group with an MMT of 278.5 ± 13.5 microns, but this was not statistically significant (P = 0.076). Macular thickness was generally lower in the SCD group in all the ETDRS map regions of the macular compared to the non SCD group with values ranging from 3.0 microns to 11.5 microns but statistically significant difference was observed only in the inner inferior macular (P = 0.026) and inner temporal macular (P = 0.046) regions. There was no statistically significant difference in distant visual acuity between non SCD and SCD participants (P = 0.605). Conclusion: This study observed focal macular thinning in SCD compared to non SCD. However, focal macular thinning was not associated with poorer distant visual acuity in patients with SCD.Item Terson syndrome: A sequel of Posterior Communicating Artery Aneurysm and a Quartet of other cases.(Wolters Kluwer - Medknow, 2025) Babalola, Y. O.; Oluleye, T. S.; Majekodunmi, O. I.; Ijaduola, M. A.This is a case series of Terson syndrome (TS) in five patients including one with features of a posterior communicating artery aneurysm. The first is a 28-year-old female who presented to the eye clinic with poor vision in both eyes for 2 weeks duration and drooping of the left upper lid. On ocular examination, she had a bilateral vitreous haemorrhage (VH). She gave an antecedent history of headaches, loss of consciousness, and seizures. Magnetic resonance angiography confirmed the diagnosis of a posterior communicating artery aneurysm. Four other patients were seen at the retina clinic with bilateral VH with a history of traumatic brain injury in keeping with TS. The second patient was a 34-year-old male referred from the neurosurgical unit on account of visual loss in both eyes. He had a preceding history of a fall with loss of consciousness and moderate head injury and best corrected visual acuity of counting fingers and hand movement, respectively, in the right and left eye. Bilateral VH was present in both eyes. The third patient was a 60-year-old male with a 2-month history of poor vision in both eyes after a head injury associated with loss of consciousness. The visual acuity was hand movement, and he had VH in both eyes. The fourth patient was a 10-year-old female who presented with poor vision for two months duration with an antecedent history of a pedestrian road traffic accident and a history of loss of consciousness. The best corrected visual acuity at presentation was 6/36 in both eyes. Ocular examination revealed bilateral VH. The fifth case was a 31-year-old male who presented with a reduction of vision in both eyes for 7 months duration with an antecedent history of a fall 2 months before the onset of symptoms. A diagnosis of TS was made in all five patients based on the clinical history and signs. The second patient was managed with bilateral vitrectomy, whereas the remaining four patients were managed conservatively.Item Diabetic Macular Oedema in Diabetic Patients attending the endocrinology clinic at University College Hospital, Ibadan(Wolters Kluwer - Medknow, 2024) Oluleye, T. S.; Babalola, Y. O.; Majekodunmi, O. I.; Ijaduola, M. A.; Fasanmade, A. A.; Alonge, T. O.; Adebusoye, S. O.Background: Diabetic macular oedema (DME), a significant threat to vision among diabetics, often eludes the early detection due to patients’ delayed ophthalmologist visits. Our efforts to increase screening participation through physician referral promotion and cost reduction have not yielded significant results. Faced with the persistent challenge of low screening rates, we sought to explore innovative alternatives to increase DME detection. The first involved implementing ophthalmologist-led screening programmes, while the second focused on promoting sponsored on-site screenings at diabetic clinics. These strategies aim to integrate DME screenings more seamlessly into routine diabetes management, potentially increasing the likelihood of early detection. By making screenings more convenient and readily available within existing care pathways, we anticipate these approaches could significantly improve participation rates and consequently lead to earlier intervention for DME amongst diabetic patients. Aim: To determine the prevalence of DME in visually asymptomatic diabetic patients through comprehensive screening and to evaluate the potential benefits of early detection in improving the visual outcomes and patient care. Methods: A cross-sectional study was conducted from 2020 to 2023, involving 225 consecutive diabetic patients who consented to participate while attending the diabetic clinic. The Joint University of Ibadan/University College Hospital Institutional Review Board provided ethical approval for the research. The study collected the data on patient demographics and medical history. Thereafter, they underwent comprehensive ocular examinations. All findings were systematically documented for analysis using the IBM Statistical Package for the Social Sciences software version 26.0. Results: A total of 225 diagnosed diabetic patients (450 eyes) were examined in the study. The duration of diabetes mellitus amongst participants ranged from two months to 30 years. The sex distribution shows a male-to-female ratio of 1:2.6, indicating a higher proportion of female participants. The age range of the study population is 31–87 years. Regarding diabetic control, 32% of participants had a fasting blood sugar (FBS) level higher than 120 mg/dL. Visual acuity (VA) assessments revealed that 16.9% (n = 38) of participants had VA worse than 6 / 12. Out of the total participants, 42 (18.9%) had DME in at least one eye, while 180 (81.1%) had no DME. DME was observed in 32 right eyes (14.7%) and 32 left eyes (14.9%). A statistically significant association was found between DME and visual impairment (χ2 = 11.2, P = 0.001), with a higher proportion of DME patients (33.3%) having visual impairment compared to those without DME (13.1%). Patients with DME were 3.6 times more likely to have best-corrected VA worse than 6 / 12 in the better eye compared to those without DME. Conclusion: This study reveals a significant prevalence of DME and its strong association with visual impairment. Our findings underscore the need to take screening services directly to diabetic clinics and the urgency of implementing routine eye screening protocols for all diabetic patients in our medical facilities to enable the early detection and timely intervention.Item Diabetic Macular Oedema in Diabetic Patients attending the endocrinology clinic at University College Hospital, Ibadan.(Wolters Kluwer - Medknow, 2023) Sarimiye, T. F.; Ijaiya-Olatoke, N.; Babalola, Y. O.; Majekodunmi, O.; Ijaduola, M. O.; Olawoye, O. O.; Oluleye, T. S.Purpose: To evaluate the rate of postoperative intraocular pressure (IOP) elevation and its management in patients who have undergone scleral buckle surgery as a primary intervention for retinal detachment. Materials and Methods: This was a retrospective review of hospital files of scleral buckle surgeries for retinal detachment from January 2016 to December 2021 at the University College Hospital Ibadan. All patients with a previous history of glaucoma, vitreoretinal surgery, or a combination of vitrectomy and scleral buckling procedures were excluded from the review. An IOP of ≥22 mmHg after surgery was considered elevated. Results: A total of 148 patients’ charts were reviewed with 125 patients (131 eyes) included in the study. There were 81 males (64.8%) and the mean age of patients was 45.2 (±18.8) years, with a range of 5–81 years. Rhegmatogenous retinal detachment accounted for 97.7% (128 eyes) of all cases and 118 eyes(90.1%) were recent detachments. Seventy‑nine eyes (60.3%) recorded elevated IOP postscleral buckle surgery. The mean elevated IOP postbuckle surgery was 27.9 (±6.2) mmHg and the mean antiglaucoma medications prescribed was 2.4 (±2) with a range of 2–5 medications. Four eyes (5.1%) needed surgical intervention for the elevated IOP. The last follow‑up mean IOP was 14.3 (±4.1) mmHg. Conclusion: Elevated IOP frequently complicates scleral buckle procedure and medical treatment is usually sufficient. As a common complication, this should be considered in advance when planning for the procedure, especially in low-income countries like Nigeria where scleral buckling surgery is still in common practice.Item Valsalva retinopathy in Ibadan(Wolters Kluwer Medknow, 2022) Babalola, Y. O.; Oluleye, T. S.; Majekodunmi, O. I.; Ijaduola, M. A.We report the cases of three patients who presented to our retinal outpatient clinic over a 3-year period with sudden visual loss and features suggestive of subhyaloid or sub-internal limiting membrane haemorrhage characteristic of Valsalva (VS) retinopathy. The first patient was a 14-year-old male student with sudden visual loss in the left eye of 2 days with a history of cough. His best-corrected visual acuity (BCVA) was 6/5 and counting fingers, respectively, in the right and left eyes. Our second patient was a 21 -year-old primigravida at the gestational age of 32 weeks who presented with sudden visual loss in the right eye of 9-day duration associated with a history of vomiting and BCVA of counting fingers and 6/6 right and left eyes, respectively, whereas the third case was a 30-year-old P2~0 (2 alive) female with poor vision in the right eye post-delivery of a live neonate through vaginal delivery with BCVA of counting fingers and 6/6, respectively, in the right and left eyes at presentation. The patients’ demographics, presentation and risk factors for VS retinopathy are discussed. All patients in this series were managed conservatively.Item Vitreoretinal manifestations of Human Immunodeficiency Syndrome in patients attending an antiretroviral therapy clinic in Nigeria: A cross-sectional study(Wolters Kluwer Medknow, 2022) Babalola, Y. O.; Oluleye, T. S.; Ashaye, A. O.Background: The human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a multi systemic disease with known manifestations involving all ocular structures from the orbit and ocular adnexa, anterior segment to the retina and vitreous. Some of these manifestations including cytomegalovirus (CMV) retinitis and HIV retinopathy are HIV/AIDS defining illnesses. The aim of this study is to determine the vitreoretinal manifestations in patients with HIV/AIDS attending an antiretroviral therapy clinic in Nigeria. Methods: This was a prospective, cross sectional study of consenting, confirmed HIV/AIDS patients attending an antiretroviral therapy clinic in Nigeria. All willing, consecutive patients who gave an informed consent were recruited. Sociodemographic data and clinical information were collected with the use of a structured interviewer–administered questionnaire. Best corrected visual acuity was recorded. Anterior segment and ocular adnexa examination was performed with a pen torch. Detailed anterior and posterior segment examination was performed with slit lamp biomicroscopy with Volks +78 diopter lens and binocular indirect ophthalmoscopy. The data were analyzed with SPSS (statistical package for social sciences) version 16. Ethical approval was obtained from the institutional ethics committee. Results: Three hundred and eighteen patients were studied of which 85 (26.7%) had disorders affecting the retina and vitreous. The female to male ratio was 2:1. More than a third of patients (38.7%) were in the 40–49 years of age group and the mean age was 47.2 years. The most common vitreoretinal lesion was presumed ocular toxoplasmosis present in 9.7% of all respondents. This was closely followed by HIV retinopathy in 3.5%, ocular tuberculosis in 1.8%, and CMV retinitis in 1.6% respondents. Two hundred and seventy seven (87.1%) respondents were on highly active antiretroviral therapy and 41 (12.9%) were not on treatment. Conclusion: A high prevalence of ocular conditions especially those affecting the retina and vitreous exists in patients with HIV/AIDS attending the antiretroviral therapy clinic in a tertiary hospital in Nigeria. Regular eye examinations are recommended for these patients to prevent potentially visual debilitating disorders.Item Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020(BMJ, 2021) Ademola-Popoola, D. S.; Fajolu, I. B.; Gilbert, C.; Olusanya, B. A.; Onakpoya, O. H.; Ezisi, C. N.; Musa, O.; Chan, R. V. P.; Okeigbemen, V. W.; Rilwan, C. M.; Malik, N. J. A.; Adio, A. O.; Bodunde, O. T.; Rafindadi, A. L.; Oluleye, T. S.; Tongo, O. O.; Badmus, S. A.; Adegbara, O. V.; Tapas, R. P.; Ezenwa, B. N.; Obajolowo, T. S.; Olokoba, L. B.; Olatunji, V. A.; Babalola, Y. O.; Ugalahi, M. O.; Adenekan, A.; Adesiyun, O. O.; Sahoo, J.; Miller, M. T.; Uhumwangho, O. M.Objectives Retinopathy of prematurity (R0P) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for R0P between 2017 and 2020 as well as the outcome of these activities in Nigeria. Design Descriptive case study. Setting Neonatal intensive care units in Nigeria. Participants Staff providing services for R0P, and 723 preterm infants screened for R0P who fulfilled screening criteria (gestational age <34 weeks or birth weight <2000 g, or sickness criteria). Methods and analysis A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity building, national and international collaborative activities between 2017 and 2018. A national protocol for R0P was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. Results In 2017 only six of the 84 public neonatal units in Nigeria provided R0P services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any R0P; and 29 (22.8%) developed type 1 R0P. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challengesincluded lack of equipment to regulate oxygen and to document and treat R0P, and lack of data systems. Conclusion R0P screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and R0P treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.Item Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020(BMJ, 2021) Ademola-Popoola, D. S.; Fajolu, I. B.; Gilbert, C.; Olusanya, B. A.; Onakpoya, O. H.; Ezisi, C. N.; Musa, O.; Chan, R. V. P.; Okeigbemen, V. W.; Rilwan, C. M.; Malik, N. J. A.; Adio, A. O.; Bodunde, O. T.; Rafindadi, A. L.; Oluleye, T. S.; Tongo, O. O.; Badmus, S. A; Adegbara, O. V.; Tapas, R. P.; Ezenwa, B. N.; Obajolowo, T. S.; Olokoba, L. B.; Olatunji, V. A.; Babalola, Y. O.; Ugalahi, M. O.; Adenekan, A.; Adesiyun, O. O.; Sahoo, J.; Miller, M. T.; Uhumwangho, O. M.Objectives Retinopathy of prematurity (R0P) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for R0P between 2017 and 2020 as well as the outcome of these activities in Nigeria. Design Descriptive case study. Setting Neonatal intensive care units in Nigeria. Participants Staff providing services for R0P, and 723 preterm infants screened for R0P who fulfilled screening criteria (gestational age <34 weeks or birth weight <2000 g, or sickness criteria). Methods and analysis A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity building, national and international collaborative activities between 2017 and 2018. A national protocol for R0P was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. Results In 2017 only six of the 84 public neonatal units in Nigeria provided R0P services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any R0P; and 29 (22.8%) developed type 1 R0P. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challengesincluded lack of equipment to regulate oxygen and to document and treat R0P, and lack of data systems. Conclusion R0P screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and R0P treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.Item Sickle Cell retinopathy: Patient awareness, mode of presentation and treatment modalities in Ibadan, South-Western, Nigeria(Wolters Kluwer Medknow, 2021) Babalola, Y. O.; Oluleye, T. S.; Majekodunmi, O. I.; Ijaduola, M. A.Background: Sickle cell retinopathy is a recognized complication of sickle cell disease (SCD) which may lead to visual impairment or blindness. Despite this, many patients with SCD hemoglobinopathy SC and SS are unaware of their genotype, hence resulting in only occasional or no eye checks with possibilities of getting blind. Purpose: The purpose of this study was to describe the genotype awareness, pattern of presentation, and treatment of sickle cell retinopathy in Ibadan. Methods: This was a retrospective review of the case notes of 64 patients with the diagnosis of sickle cell retinopathy seen over two years (January 2018 to December 2019). Sociodemographic characteristics, clinical data, ophthalmic assessment, and treatment performed on patients were extracted onto pro forma. Information obtained included age, sex, sickle cell genotype, genotype awareness from their medical history, retinal findings using Goldberg classification, and treatment modalities for the patients. Data analysis was performed using the IBM SPSS software version 22. Analysis was done using proportions and percentages. Results: Medical records of 64 patients were reviewed. The mean age of the patients was 39.05 ± 10.48 (range: 20–65) years, with a male to female ratio of 1.8:1. Sixty (93.8%) patients had genotype SC. Forty six (71.8%) patients were aware of their genotype. Fifty six patients presented with Proliferative sickle cell retinopathy (PSR) in the right eye, while 55 had PSR in the left eye. These spanned all the different grades of PSR. Treatment offered at the first visit included laser photocoagulation, intravitreal anti vascular endothelial growth factor (bevacizumab), vitrectomy, and scleral buckle. At subsequent follow-up visits, detailed ocular examination on patients was done to look out for new/active lesions. If any of these lesions were found, repeat or additional treatment was offered to help stabilize and/or improve the best corrected visual acuity of patients. Conclusion: This study has demonstrated high genotype awareness among the studied patients. Despite this high awareness, majority of our patients presented with varying stages of proliferative sickle cell retinopathy. While our patients had more than one type of treatment, some defaulted due to lack of funds. Therefore, to improve the quality of life of SCD patients, it is essential for health-care providers and other stakeholders to design policies for sustainable and accessible eye care programs to avoiding needless blindness from sickle cell retinopathy.Item Visual Outcomes of Anti-Vascular Endothelial growth factor injections at the University College Hospital, Ibadan.(Wolters Kluwer Medknow, 2021) Babalola, Y. O.; Oluleye, T. S.; Ijaduola, M. A.; Adewole, T. A.Aim: The aim of the study was to evaluate the 1 year outcome of intravitreal anti vascular endothelial growth factor (anti VEGF) therapy in an eye unit in sub-Saharan Africa. Methodology: This retrospective study included 182 eyes of 172 patients managed in the vitreoretinal unit between 2016 and 2019 who were treated with intravitreal anti VEGF bevacizumab (1.25 mg/0.05 ml) with at least 1 year of follow up. The outcome measures were change in best corrected visual acuity (BCVA) over 1 year of follow up, the number of injections taken, and complications. Results: The mean age was 61.1 ± 16.3 years (male to female ratio of 1:1.1) and about 62.1% above >60 years. A total of 330 injections were given during the period audited. The mean number of injections was 1.8 ± 0.93. Ninety four (51.7%) eyes had only one injection, while 33 (18.1%), 50 (27.5%), and 5 (2.7%) had 2, 3, and 4 injections, respectively. About 78.5% had moderate to severe visual impairment at baseline and 44.5%, 16.4%, 12.6%, and 7.1% at 1, 3, 6, and 12 months post injections, respectively. The mean BCVA improved for all eyes from 1.67 ± 0.91 logarithm of minimum angle of resolution (logMAR) at baseline to 1.50 ± 1.27 logMAR at 1 year. The logMAR letters gained was 23 at 1 month and 8.25 at 1 year; the eyes that had three injections gained 10 letters, while those that had one injection gained three letters. Eyes with age related macular degeneration and idiopathic polypoidal choroidopathy gained 7.5 and 9 letters, respectively, at 1 year after at least three injections. There was a statistically significant association between an increasing number of injections and improved visual outcome (P = 0.043). One patient each developed endophthalmitis (0.6%) and inferior retinal detachment (0.6%) post injection. Conclusion: Visual acuity gain was recorded in patients who had intravitreal anti VEGF injections in 1 year. It is recommended that patients should have more than one injection.
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